Many of us have been waiting to hear the final word about what’s next from CMS for the Next Generation ACO Model. On May 21, 2021, CMS’s Innovation Center (“CMMI”) confirmed that the Next Generation ACO Model would not be extended and will conclude at the end of this year as planned. The Next Generation ACO Model has been the most advanced value-based contracting model offered by CMS with participating risk-bearing entities taking between 80%-100% upside and downside risk.  However, according to reports, the model didn’t achieve sufficient savings to justify making it a permanent CMMI program.

Recognizing that Next Generation ACOs have developed advanced operational capabilities that can be leveraged, CMMI is giving Next Generation ACOs an opportunity to request to participate in the second year of the Global and Professional Direct Contracting (“GPDC”) Model starting in PY 2022 as a Standard Direct Contracting Entity.  To participate, existing Next Generation ACOs must meet the GPDC Model requirements and must submit application materials to CMS by June 14, 2021.  In addition, Next Generation ACOs that do not participate in the GPDC Model will have the option to apply to participate in the Medicare Shared Savings Program (“MSSP”) for 2022.

Industry response has been relatively tepid, expressing disappointment at the conclusion of the Next Generation ACO model, but relief that Next Generation ACOs will have an opportunity to continue operating in the GPDC Model or under the MSSP.  Without formal guidance, it is not clear whether Next Generation ACO participation in the Direct Contracting program will include only Medicare or both Medicare and Medicaid.

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Photo of David Manko David Manko

David is Chair of the Firm’s Health Care Group, with a national practice representing clients in the health care services sector in complex business transactions (private equity, M&A and joint ventures) and regulatory matters. After more than 25 years, David has developed deep…

David is Chair of the Firm’s Health Care Group, with a national practice representing clients in the health care services sector in complex business transactions (private equity, M&A and joint ventures) and regulatory matters. After more than 25 years, David has developed deep healthcare industry expertise which he leverages to provide practical, creative and actionable advice to clients. Recently, David has been involved with representing stakeholders as they navigate a shifting healthcare landscape arising from COVID-19 including CARES Act compliance matters and implementing new healthcare delivery models.

Chambers USA recognizes David as a regulatory and transactional healthcare lawyer who earns impressive reviews from peers and clients alike.” “He is a master negotiator and is second to none in his responsiveness,” says one commentator, who adds that “he turns around whatever needs to be done promptly and efficiently.”

As one of the architects of the NYS ACO statute and regulations and a former member of the NYS Value Based Payment Workgroup, David has deep expertise in regulatory and transactional  issues involving large provider networks and risk bearing entities. David has also worked with clients to develop demonstration projects with the Center for Medicare and Medicaid Innovation.

In the community, David is dedicated to expanding access to primary care services for underserved populations. For almost 10 years, he has been an active member of the Board of Directors of Primary Care Development Corporation (“PCDC”). PCDC is a nonprofit Community Development Financial Institution dedicated to providing low-cost debt financing to not-for-profit organizations to expand and improve primary care in underserved communities.